Shock physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Physical Examination

A normal pulse rate is seen in some cases of shock, a phenomenon sometimes confusingly described as relative bradycardia. Paradoxical (absolute) bradycardia is also described. Compensatory mechanisms in the elderly can also be less pronounced and so the typical pattern above may not be seen. Also, young, very fit patients may be able to compensate so well that physiological derangements only manifest when the shock is very severe and sudden decompensation occurs.

Hypovolemic shock

Appearance of the Patient

• Anxiety, restlessness, altered mental state due to decreased cerebral perfusion and subsequent hypoxia.
• Fatigue due to inadequate oxygenation.

Vital Signs

• Blood Pressure: Hypotension due to decrease in circulatory volume.
• Pulse: A rapid, weak, thready pulse due to decreased blood flow combined with tachycardia.
• Temperature:Hypothermia due to decreased perfusion and evaporation of sweat.

Skin

• Cool, clammy skin due to vasoconstriction and stimulation of vasoconstriction.
• Mottled skin (cutis marmorata), especially extremities, due to insufficient perfusion of the skin.

Eyes

• Distracted look in the eyes or staring into space, often with pupils dilated.

Throat

• Thirst and dry mouth, due to fluid depletion.

Lungs

• Rapid and shallow respirations due to sympathetic nervous system stimulation and acidosis.

Cardiogenic Shock

Vital Signs

• Pulse: Absent pulse due to tachyarrhythmia.

Neck

• Distended jugular veins due to increased jugular venous pressure.

Obstructive Shock

• Obstructive shock, similar to hypovolaemic shock but in addition:
  • Distended jugular veins due to increased jugular venous pressure.
  • Pulsus paradoxus in case of tamponade
• Septic shock, similar to hypovolaemic shock except in the first stages:
  • Pyrexia and fever, or hyperthermia, due to overwhelming bacterial infection.
  • Vasodilation and increased cardiac output due to sepsis.
• Neurogenic shock, similar to hypovolaemic shock except in the skin's characteristics. In neurogenic shock, the skin is warm and dry.
• Anaphylactic shock
  • Skin eruptions and large welts.
  • Localised edema, especially around the face.
  • Weak and rapid pulse.
  • Breathlessness and cough due to narrowing of airways and swelling of the throat.